Why the study?
The atherothrombotic and bleeding risks of discontinuing both components of DAPT before surgery in patients with an intracoronary stent after 1 year remained unclear.
Does preoperative discontinuation of both antiplatelet agents reduce bleeding without increasing MACE in patients undergoing surgery >1 year after percutaneous coronary intervention?
Does preoperative discontinuation of both antiplatelet agents reduce bleeding without increasing MACE in patients undergoing surgery >1 year after percutaneous coronary intervention?
Preoperative discontinuation of both antiplatelet agents >1 year after PCI appears safe regarding ischemic events and reduces bleeding risk compared to continuing at least one agent.
Discontinuing both antiplatelet agents after 1 year was not linked to higher MACE but fewer transfusions; leaves open optimal perioperative DAPT strategy.
OBJECTIVE: The aim of this study was to investigate the atherothrombotic and bleeding risk of discontinuing both components of dual antiplatelet therapy (DAPT) before surgery in patients with an intracoronary stent after 1 year. METHODS: We retrospectively enrolled 212 patients who received an evaluation of perioperative cardiac risk and underwent surgery from March 2017 to March 2019. We divided them into 2 groups: the discontinuation of both antiplatelet agents group (DCAP, no use of any antiplatelet agent) and the continuation of at least 1 antiplatelet agent group (CAP). The primary composite endpoint was the occurrence of major adverse cardiovascular events (MACE), including death, angina, postoperative coronary angiography, stroke, and readmission within 30 days postoperatively. The second endpoint was bleeding requiring the transfusion of ≥2 packs of red blood cells (RBCs). RESULT: =0.347) were not significantly different between the groups. CONCLUSION: Preoperative discontinuation of DAPT did not increase the risk of MACE. However, continuation of at least 1 antiplatelet agent increased the incidence of bleeding requiring RBC transfusion. Further research with a large cohort is warranted.
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Lee et al. (2020) studied this question.
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